Healthcare Provider Details

I. General information

NPI: 1215262779
Provider Name (Legal Business Name): MARGARET VINOLUS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY SUITE 825
EUGENE OR
97401-3143
US

IV. Provider business mailing address

3956 SHASTA VIEW ST
EUGENE OR
97405-5868
US

V. Phone/Fax

Practice location:
  • Phone: 541-517-4689
  • Fax: 541-345-0300
Mailing address:
  • Phone: 541-345-0300
  • Fax: 541-345-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL4455
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: